Before US Agency for International Development (USAID) Administrator Rajiv Shah uttered the first word of his National Institutes of Health (NIH) Barmes Lecture today, NIH Director Francis Collins called attention to the symbolism of the moment: He said it marked the first time that a sitting USAID leader had spoken at NIH.

But Shah had more than symbolism in mind.

Instead, he outlined an ambitious agenda for advancing the US government’s global health priorities, and he pinpointed one critical fact: To meet these goals, we need more than existing tools.

He called for a broad new whole-of-government approach when it comes to global health research and development. Before an audience who understood well his meaning, Shah articulated a vision of USAID, NIH, the US Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and other partners working together more efficiently and more wisely in using research to reduce the death toll of diseases that affect the poorest people in the world. His call for greater cooperation, backed by inspired leadership at NIH and CDC, could put us on a path that accelerates a recent string of successes in global health research and development.

The key word is “could.” Now, many people will be watching to see what happens next.

USAID plays a critical role in this. It has a presence in more than 100 countries. It knows what works on the ground. It has people who understand local health systems . It has lots of experience in delivering better health care and then taking small projects national. So when it comes to new inventions—Shah’s word—USAID is the agency best positioned to determine if they work in the developing world.

But Shah said rightly that the current path isn’t going to be enough to reach an incredibly ambitious set of goals for the Global Health Initiative in five years: Saving the lives of more than 3 million children, preventing more than 12 million HIV infections, averting 700,000 malaria deaths, ensuring nearly 200,000 pregnant women can safely give birth, preventing 54 million unintended pregnancies, and curing 2.4 million people infected with tuberculosis.

As important as it is to set these goals in order to inspire others around the world to act urgently, it’s also critical to foster new scientific innovation in order to get the job done. His case on malaria was particularly poignant.

Shah said that if current efforts to develop new tools against malaria are not sustained, history tells us that the epidemic will simply come back again with full force and that all those gains will be lost. He spoke movingly of the power of vaccines for this and other diseases, from the promising RTS,S malaria vaccine, now in a Phase 3 trial with preliminary results expected later this year, to a growing body of other mostly childhood vaccines including a pneumococcal vaccine and a rotavirus vaccine.

To keep our momentum in improving health around the world, we also have to remember our recent past. Over the last decade, presidential leadership coupled with a bipartisan group of champions in Congress have built a historical record in saving lives in the developing world—first through the President’s Emergency Plan for AIDS Relief and now increasing through the President’s Malaria Initiative. We need this bipartisanship to not only survive but to thrive.

Shah importantly called for new mechanisms to measure whether these new global health initiatives are actually working through the development of goals and strategies, a center of excellence, and an annual accountability review of global health technology. We need to know more about how these would be implemented, and what they would measure. With new and effective measurement, we can learn much more about what works and what doesn’t, and show US taxpayers that their money is having huge impact overseas. We also need to hear more about this from the leaders of other agencies that are partnering with USAID, including Francis Collins, CDC Director Thomas Frieden, and FDA Commissioner Peggy Hamburg.

One final point, and it underscores an earlier one: US agencies that oversee scientific research need to work well together. Shah and other leaders should now hold a series of public meetings on this new ambitious, coordinated research agenda—an agenda that not only attacks the world’s most deadly diseases but also unleashes innovation from a national treasure: Our scientists at work.

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